Provider Demographics
NPI:1215967963
Name:WENZEL, EVETTE S (MD)
Entity type:Individual
Prefix:DR
First Name:EVETTE
Middle Name:S
Last Name:WENZEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EVETTE
Other - Middle Name:SUE
Other - Last Name:POLCZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:1825 RTE 35
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3541
Practice Address - Country:US
Practice Address - Phone:732-280-2600
Practice Address - Fax:848-469-8933
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09556200207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68431279Medicaid
CO518698Medicare ID - Type Unspecified
COH83260Medicare UPIN